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General NPI Number Information
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NPI Number | 1689213902
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Entity Type | Organization
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Legal Business Name | PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLE TENNESSEE, PLLC
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 100 SPRINGHOUSE COURT STE. 220
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-1610
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Country | US
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Telephone | 615-264-6404
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Fax | 615-264-0689
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Provider Business Mailing Address
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Address Line | 100 SPRINGHOUSE COURT STE. 220
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-1610
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Country | US
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Telephone | 615-264-6404
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Fax | 615-264-0689
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Authorized Official
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Title or Position | PERIODONTIST/OWNER
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Name | DR. ROBERT P PULLIAM
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Credential | DMD, MS
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Telephone | 615-264-6404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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